Wednesday, December 6, 2023
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Briefly, the most common indications for cesarean deliveries include failure to progress, nonreassuring fetal status, prior cesarean delivery or hysterotomy, and fetal malpresentation. These account for more than 70% of the indications for cesarean section. Notably, several of these conditions rely on a degree of clinical judgment and management style as to when the indication is present for the cesarean section to be performed. Some other, less common indications for cesarean deliveries include abnormal placentation, mechanical obstruction of the birth canal, maternal infections (eg, herpes, HIV), fetal bleeding diathasis, and cervical cancer.
In many of the above circumstances, the benefits of cesarean delivery seem apparent; although given that the diagnosis of these conditions is often not clear-cut, the benefit to the fetus is also not clear-cut. For example, the false-positive rate in the interpretation of fetal heart monitor tracings is extremely high;[1,2] many cesarean sections are performed needlessly to expedite the delivery of a fetus who is tolerating labor without difficulty.
Cesarean deliveries do have a number of other clear benefits, particularly if they are planned. For example, knowing what day the baby will be born facilitates arranging childcare and planning when to return to work. Additionally, it helps to ensure that a specific provider will be present to perform the delivery. Although these benefits may seem trivial to some, for certain families these can be of utmost importance.
A planned cesarean delivery also guarantees that a pregnancy will not go post-term. As most are performed at 39 weeks of gestation, the risk of intrauterine fetal demise beyond 39 weeks is eliminated, and the risk of the development of post-maturity syndrome (meconium aspiration syndrome) is greatly reduced. Given the rarity of these disorders, however, many cesarean deliveries would have to be performed to avert a single adverse outcome due to one of these conditions.
